Aims and Objectives Acute aortic syndrome (AAS) is an uncommon but life-threatening diagnosis. Symptoms suggesting AAS are very common, so clinical scores and blood tests may be needed to select patients for definitive imaging. We aimed to evaluate the diagnostic accuracy of the aortic dissection detection risk score (ADD-RS) used alone or in combination with D-dimer for detecting AAS in patients presenting with symptoms suggestive of AAS.

Method and Design We searched MEDLINE, EMBASE, and the Cochrane Library from inception to February 2024, along with the reference lists of included studies and other systematic reviews. All diagnostic accuracy studies that assessed the use of ADD-RS alone or with D-Dimer for diagnosing AAS compared with a reference standard test were included. Two reviewers independently selected and extracted data. Risk of bias was appraised using QUADAS-2 tool. Data were synthesised using hierarchical meta-analysis models.

Results and Conclusion We selected 13 studies from the 2017 citations identified, including six studies evaluating combinations of ADD-RS alongside D-dimer>500ng/L. The methodological quality of the included studies was variable, with most studies having low or unclear risk of bias and applicability concerns in at least one item of the QUADAS-2 tool. The table shows the summary sensitivities and specificities (with 95% credible and predictive intervals) of ADD-RS at thresholds of greater than zero and greater than one, and combinations of the ADD-RS and D-dimer.

The ADD-RS can be used alone or alongside D-dimer to identify AAS with a range of trade-offs between sensitivity (93.1% to 99.8%) and specificity (21.8% to 67.1%). A combination based on the Canadian Clinical Practice Guideline may represent the best trade-off, with sensitivity of 93.1% and specificity of 67.1% for AAS.